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March 20, 2012 Get Retirement News  |  Advertise  |  Unsubscribe  |  Past Issues  |  Search

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[Official Guidance]
24 'Frequently Asked Questions' and Their Answers, on the Requirement of a Summary of Benefits and Coverage, as Issued by EBSA
24 Q&As, called 'Part VIII' of the agency's Q&As on the Affordable Care Act. No extension of the generally applicable September 23 effective date was provided. Other highlights: Plans and issuers are not required to provide a separate SBC for each coverage tier; a plan or issuer with a carve-out arrangement with a PBM or other organization can delegate to that organization the duty to provide the SBC, but the plan or issuer remains responsible if the plan or issuer knows the SBC hasn't been done properly; FSA, HSA, HRA and similar benefit add-ons can be described in the same document used for the health plan; COBRA qualified beneficiares are entitled to an SBC; circumstances allowing electronic distribution of the SBC are prescribed; model language is provided for postcards or emails about evergreen website postings; the SBC cannot simply cross-reference the terms of a Summary Plan Description; and the SBC is not required to include a statement as to the health plan's grandfathered status (but can, if desired). (Employee Benefits Security Administration)

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[Official Guidance]
HHS Final Rule on PPACA Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (PDF)
"This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment consistent with title I of [PPACA] as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ... are implemented, starting in 2014." (Department of Health & Human Services)

[Guidance Overview]
Cafeteria Plan Premium Payment Did Not Take Insurance Arrangement Out of ERISA's Voluntary Plan Safe Harbor
"Other courts have concluded that payment of voluntary plan premiums through a cafeteria plan weighs against the safe harbor, even if not a deciding factor on its own.... In contrast, this and another recent decision ... seem to suggest that cafeteria plan use alone might not rule out the safe harbor." (Thomson Reuters/EBIA)

'Impact Analysis' of Various Health Care Reform Regs: Establishment of Exchanges and Qualified Health Plans, Exchange Standards for Employers, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (PDF)
"Executive Orders 12866 and 13563 direct agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity)." (Center for Consumer Information & Insurance Oversight)

At Heart of Health Law Clash, a 1942 Case of a Farmer's Wheat: What is 'Interstate Commerce'?
"If the Obama administration persuades the Supreme Court to uphold its health care overhaul law, it will be in large part thanks to a 70-year-old precedent involving an Ohio farmer named Roscoe C. Filburn.... [However, b]oth supporters and opponents of the health care law say the decision helps their side, and for three days starting next Monday, it will be at the center of the arguments before the Supreme Court about the law's constitutionality." (The New York Times; free registration required)

ML Strategies' Health Care Reform Update, March 19, 2012 (PDF)
Read this week's update on health care reform legislation, regulations, and initiatives. (ML Strategies, LLC)

Key Health Law Question for High Court: How Far Does Congress' Power Reach?
"Media outlets analyze the questions, personalities and precedent-setting issues that will be in play as the Supreme Court takes up the constitutionality of the health law." (Kaiser Health News)

Mid-Market Employer to Build On-Site Wellness Clinic for Plant's 300 Employees
"Scheduled to open this summer, Hatco's Health and Wellness Center will provide a range of wellness services to the plant's 300 employees and their dependents[.] These include preventative health screenings, adult immunizations, acute medical care, prescription services and chronic disease treatment." (Business Insurance; free registration possibly required)

Will Health Care Reform Impact Applications for Disability Benefits?
"The cost of maintaining health insurance coverage during a period lasting at least 24 months (the SSDI 5-month waiting period plus the 19-month Medicare waiting period) creates a disincentive to apply for SSDI benefits, generating 'job lock' -- the inability of a worker to freely leave an employer because doing so would result in loss of employer-provided benefits, like health insurance." (RAND)

Pathways from Disability Onset to Retirement: The Roles of Employer Accommodation and Health Insurance
"How workers and their employers adapt to the onset of a disability is important. A policy that requires employers to provide private disability insurance benefits in the first two years after disability onset may be one way to encourage firms to take greater steps to rehabilitate and accommodate disabled workers. A similar policy implemented in The Netherlands resulted in a 25 percent reduction in the number of disabled beneficiaries per worker." (RAND)

The Health Care Law & Women
"In the past, women often had to pay more for coverage that sometimes didn't even cover their needs — that's changing under the health care law. Over 20 mil.lion women with private health insurance are receiving expanded preventive services with no cost-sharing, including mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits." (

Opinion Leaders and Media Coverage: The Link between Market Reforms and the Mandate
"It's important to note that opinion leaders of all stripes and news outlets have been noting the inextricable link between the market reforms included in the ACA and the individual mandate. [Here are some highlights of recent coverage] noting this link[.]" (America's Health Insurance Plans)

Employee Who Exhausts Leave Has No Claims under the ADA or FMLA, Says 10th Circuit
"The court found neither law applied because the employee had exhausted his 12-week annual leave entitlement under the FMLA and could not perform his job's essential functions even with a reasonable accommodation, as required by the ADA." (Mercer)

Cost of Long-Term Care Insurance Keeps Rising
"The American Association for Long-Term Care Insurance says its yearly analysis of popular policies offered by 10 big insurers finds that prices for such policies have risen by as much as 17 percent from a year ago." (The New York Times; free registration required)

The Promise and Peril of Health Care Forecasting
"The growing use and increased sophistication of electronically mediated patient-level forecasting presents challenges for ethical use and opportunities for innovative applications. Health plans, method developers, and policy makers should adopt strategies that directly address these issues in order to maximize the benefit of healthcare forecasting on the longterm health of patients." (The American Journal of Managed Care)

Impact of an Online Prescription Management Account on Medication Adherence
"Patients who utilized an online prescription management account had higher rates of medication adherence as compared with nonusers. Additional studies are needed to assess which specific components of the prescription management account have the biggest impact on adherence." (The American Journal of Managed Care)

DOL's 'Good Faith' Compliance Standard for SBC Rules Fails to Relieve Burden on Employer Plan Sponsors
"'We are very disappointed that guidance ... by the departments of Health and Human Services, Labor and Treasury has reiterated that employers will have as little as six months to comply with the ... Summary of Benefits and Coverage (SBC) regulations that the federal government itself was nearly a year overdue in finalizing' Council President James A. Klein said ... following DOL's release of a new Frequently Asked Questions (FAQ) document on the SBC requirements." (American Benefits Council)

Benefits in General; Executive Compensation

Employers' Accounting for Pensions and Other Retirement Plans Might Be on FASB's 2012 Agenda
"Employers' accounting for pension, retiree medical and other post-retirement benefits — specifically, the expected rate of return on plan assets and combining of various expense elements — tops a list of new concerns stakeholders want FASB to address, according to Chairman Leslie Seidman's March 12 webcast on 2012 priorities." (Mercer)

Some Companies Turning to Personal Concierge Services in Effort to Improve Productivity
"The idea is to let someone else plan employees' trips — both for work and leisure — find them a plumber or a dog sitter, or choose where to take their car for an oil change." (The New York Times; free registration required)

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